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WALGREEN CO.
DSH050276G CONTRA COSTA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CONTRA COSTA REGIONAL MEDICAL CENTER
Subdivision Name
BRENTWOOD HEALTH CENTER
Type
Disproportionate Share Hospital
340B ID
DSH050276G
Entity Address
BRENTWOOD HEALTH CENTER
171 SAND CREEK ROAD, SUITE A
BRENTWOOD, CA 94513-2033
Medicare Provider Number
050276
Outpatient Facility Provider Number
Participating Start Date
4/1/2007
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 15947
13691 SAN PABLO AVE
SAN PABLO, CA 94806
Pharmacy Comments
Contract Details
Approval Date
7/1/2008
Contract Begin Date
7/1/2008
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
6/11/2008
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